Qigong

Does it work ?

Systematic reviews

Five systematic reviews of qigong in cancer have been published and are described in table 1. They cover a range of outcomes and cancer types and include between nine and 23 studies. All of the reviews included only randomized or non-randomized controlled clinical trials.

The most recent review published in 2016 included 11 randomized clinical trials which had qigong or tai chi performed as qigong as the main intervention15. The strongest evidence was for fatigue, quality of life (QoL), and immune function/biomarkers of inflammation. For each of these outcomes, four of the five studies assessing these outcomes reported significant group differences in favour of qigong. However, all of the included studies had some potential for bias, particularly due to lack of blinding.

The results of this systematic review are generally in line with those of previous reviews, which also found that the best evidence was for improvements in immune function16,17,18. and quality of life16,18. One older systematic review concluded that the methodological quality of qigong trials was too poor to support its effectiveness for people with cancer19. However, a number of more rigorous, controlled trials have been published since this review with consistent positive findings for some outcomes.

In summary, systematic reviews of qigong for cancer have found some positive results, particularly for fatigue, quality of life and immune function. However, all of the reviews highlight the methodological limitations of the trials.

Controlled clinical trials

Seven RCTs and three non-randomized controlled trials have been published that are not included in any of the above reviews. These trials are described in table 2. Collectively, these trials report mixed results and are heterogeneous in terms of the clinical characteristics of the cohorts and the outcomes assessed. There is evidence from one trial [reported in 21,22] that adds to the findings of the systematic reviews, which is that the most consistent evidence is for improvements in fatigue, immune function and quality of life. However, two trials found no significant differences in fatigue24,26 and one found no significant differences in quality of life [26]. There are no consistent findings across the other trials and all of the trials are impeded by methodological limitations.

A 2017 two-arm randomized cross-over trial (n=19) found that qigong and standard endurance training (SET) were equivalent in their impact on psychological outcomes in patients with advanced cancer20. The authors failed to reach their recruitment target and only 19 patients completed both interventions and all assessments, reducing the validity of this trial.

One single-centre randomized controlled trial reported in 21 and 22 (n=100 and n=108 respectively) measured the effects of Chan-Chuang qigong in non-Hodgkin’s lymphoma patients undergoing chemotherapy. Participants in the qigong group had significant improvements in fatigue, white blood cell counts, haemoglobin levels, sleep quality and quality of life, but not platelet counts, compared to the usual care control group. Lack of a placebo control group and the same researcher carrying out the intervention and the data collection reduces the validity of this trial.

A double-blind, randomized controlled pilot study (n=87) explored the effects of a set of combined qigong/tai chi easy exercises on breast cancer survivors23. Both the qigong/tai chi easy and sham qigong groups had improvements in physical and mental health, level of physical activity, self-reported cognitive function and performance in cognitive function tests. There were no significant differences between the two groups except for decreased Body Mass Index (BMI) in the qigong group for a subset of participants who enrolled late in the study. The sham qigong intervention comprised gentle exercise without a meditative/breath focus. The qigong/tai chi easy intervention may not have been different enough from the sham qigong intervention to demonstrate changes in outcomes beyond what gentle exercise can do.

A randomized controlled trial (n=90) measured the impact of a combined qigong/tai chi intervention on sleep and fatigue in prostate cancer patients undergoing radiotherapy24. The qigong/tai chi group reported longer sleep duration midway through radiotherapy compared to the sham qigong group but this was not sustained over time. No differences between groups were reported for other outcomes. The validity of this trial is affected by several limitations described in table 2.

A relatively large (n=192) RCT reported increased cortisol levels in the qigong group compared to the waiting list group, indicating higher stress25. However, there were no perceived changes in stress amongst the participants and as exercise can increase salivary cortisol, the authors acknowledge that salivary cortisol may be an inappropriate measure of stress after an exercise intervention.

A very small feasibility randomized controlled trial (n=27) explored qigong for women with metastatic breast cancer26. There were no significant differences in quality of life, fatigue, perceived stress or sexual outcomes between the qigong and meditation control groups.

Three non-randomized controlled trials27-29. have reported mixed results. One study (n=23) found decreased upper limb circumference and increased blood flow in breast cancer patients with lymphedema27. Two studies measured the effects of qigong for nasopharyngeal cancer survivors. The first study (n=52) found no significant improvements in quality of life, functioning or symptoms in either the qigong or standard care group28. The other trial (n=52) found that the qigong group had higher blood flow velocity, lower arterial resistance, higher palmer skin temperature and better aerobic capacity then the control group receiving usual care29. Small sample sizes and lack of randomization affect the quality of these trials.

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